Mammography examinations

ABSTRACT

The invention relates to an arrangement in connection with a mammography apparatus, in the invention, a screen or a user interface with a screen is attached to the mammography apparatus, which attachment is realized such that the screen or the user interface with a screen is aligned or can be aligned at least partly towards a lower tray structure of the mammography apparatus. Such screen or a user interface with a screen can be arranged in a functional connection with an information system and patient images recorded earlier in the information system can be displayed on the screen or the user interface with a screen.

This application is a continuation-in-part filing claiming priority toInternational Application No. PCT/FI2014/050930, the disclosure of whichis herein incorporated by reference.

FIELD OF THE INVENTION

The present invention relates to an arrangement and method to facilitatemammography examinations.

DESCRIPTION OF PRIOR ART

Breast cancer is the most common type of cancer in women. According toinvestigations, about one in every ten women contracts breast cancer atsome point in their lives. When breast cancer is detected on the basisof symptoms, the illness often has already developed to a stage wherethe prognosis for recovery is relatively poor. Some of the cases aredetected in screening programs arranged in many countries for women overthe age of 40. Screening often reveals a cancer at a very early stage,so its treatment can be started in time and recovery is thus morelikely.

Mammography is a widely used method in breast cancer screening as aclinical investigation method and also in follow-up diagnosis.Mammography is an X-ray imaging method wherein an apparatus specificallydesigned for this purpose is used. In screening studies, mammography hasbeen reported to have a sensitivity of 90-93% and a specificity of90-97%. This indicates that screening studies are useful and that earlydetection of breast cancer by screening can save human lives. It hasbeen established that mammography reduces breast cancer mortality by 35percent among women over 50 and by 25-35 percent among women at the ageof 40-50 years.

The mammography images are examined to detect various anomalies in thebreast, such as calcifications, i.e. small deposits of calcium in thesoft breast tissue. A calcification generally cannot be detected byfeeling the breast, but it is visible in the x-ray image. Largecalcifications are generally not associated with cancer, but clusters ofsmall calcium deposits, i.e. so-called micro-calcifications, are anindication of extra breast cell activity, which may be associated withbreast cancer. Other features to be detected by mammography includecysts and fibroadenomas, which, however, are generally not associatedwith cancer.

In conventional screening mammography, the breast gland is typicallycompressed between two compression plates and exposed to radiation atleast twice, from above and from an oblique direction. If necessary, anadditional third image is taken squarely from the side. As in suchimaging the tissue layers lie on top of each other in the direction ofthe x-ray beam, these irradiations produce two-dimensional images inwhich strongly absorbing structures may hinder the detection ofstructures lying beneath them.

Continual improvement in mammography has led to novel type ofmammography methods and devices that produce tomographic images of apatient's breast. In these solutions, several projections of the breastat different angles are produced and an image is generated by using anapplicable reconstruction algorithm. From the image information, i.e.from the individual images, typically several images are constructedwhich represent layers of the breast oriented in parallel with thesurface of the x-ray detector, thus making possible to detect tissuestructures laying on top of each other.

A typical digital mammography apparatus comprises a frame part and aC-arm or a corresponding structure rotatably connected to the framepart. At the first end of the C-arm, there is arranged an x-ray sourceand at the second end, a radiation detector. A term imaging means isoften used for these devices. Disposed substantially in the regionbetween said x-ray source and detector, typically at a close proximityto the detector, a compression structure is arranged which is designedto position a breast as compressed for the duration of an exposure.

Mammography patients often experience varying degrees of anxiety thatmay be related not only to the general fear regarding a possible diseasethe examination may discover as such but also, for example, to the fearof physical pain the compressing of a breast for the imaging process orthe injecting of a biopsy needle into the breast tissue causes. As thepatient's anxiety may affect the patient's behavior, and thus thesuccess of the imaging or sampling, all means by which the patient'sfears can be alleviated are welcomed.

User interfaces of the mammography apparatus are traditionally fixedstructures and as the name suggests, specifically designed to be used bythe user of the apparatus. Traditionally, mammography apparatus have notbeen arranged with means for presenting information to a patient.

In mammography, it is known to use images taken of the patient earlieror during the ongoing operation as a source of information for takingnew images, or for biopsy. It is known to use information one can getfrom such images to facilitate patient positioning, when the same objectis being imaged anew, or when one is about to initiate a biopsy, orduring it. According to the prior art, such images taken earlier havebeen studied at a workstation, which typically has not been arrangedimmediately next to the mammography apparatus. This means that theinformation relevant for positioning, established at the workstation,just has to be remembered and figured out correctly after havingreturned to the mammography apparatus from the workstation.

SUMMARY OF THE INVENTION

The object of the present invention and its preferable embodiments is toaccomplish a new kind of mammography apparatus including integratedsolutions thanks to which the biopsy operation or the positioning of thebreast for the imaging may be facilitated. On the other hand, preferableembodiments of the invention can alleviate the patient's fear relatingto an upcoming operation or during it.

The object of the invention is achieved by a solution of theaccompanying independent claims. Some preferable embodiments of theinvention have been presented in the accompanying dependent claims. Itis essential to the invention to implement an arrangement integrated tothe mammography apparatus which enables presenting images taken of thepatient on a screen, which is arranged to the mammography apparatus inthe immediate vicinity of its imaging station.

Thus, a mammography apparatus according to the invention is arrangedwith a screen (17) or a user interface with a screen (17), which isbrought into a functional connection with an information system in whichimages taken of a patient are recorded. A memory of this informationsystem can comprise a memory arranged in connection with the mammographyapparatus or a memory separate to that, or both. When images taken of apatient earlier are studied, according to the prior art, at someseparate workstation, the present invention provides an opportunity tobring such images to the immediate vicinity of a place where informationone can get from the earlier images can be directly utilized tofacilitate positioning. Preferably, the arrangement includes apossibility to present the images taken of the patient earlier in thesame orientation in which the breast is being positioned to the imagingapparatus.

On the other hand, preferable embodiments of the invention provide a newway to guide and calm the patient and to provide information to thepatient prior to or during an imaging or biopsy procedures. Thanks toembodiments of the invention, the patient can be provided information onwhen exactly an exposure will begin and the patient should be still, forexample, or how long the operation will still last.

According to a further embodiment, a method for positioning a breast toa mammography apparatus is provided. In this method an image taken ofthe breast is used as an aid for positioning the breast, wherein theimage of the breast is a patient image recorded earlier in aninformation system external to the mammography apparatus. According tothe present embodiment, the earlier image is presented on a screen or auser interface with a screen attached to the structure of themammography apparatus.

According to an additional embodiment, a mammography imaging arrangementis provided. The arrangement includes a frame or a frame part attachableto a wall or a ceiling and an arm structure connected to said frame orframe part and pivotable in relation to a horizontal rotation axis. Thearm structure includes an X-ray source and an image data receivingmeans. The arrangement further includes a control system including auser interface arrangement and at least one screen or user interfacewith a screen, wherein the control system is connected to an externalinformation system remote from the mammography imaging arrangement suchthat patient images recorded remote from the mammography imagingarrangement can be displayed on said screen and/or used in positioningthe breast and/or the arm structure during imaging.

DETAILED DESCRIPTION OF THE INVENTION

In the following, some embodiments of the invention and their benefitswill be described in more detail, also with help of the attachedfigures, of which figures

FIG. 1 shows a basic structure of one mammography apparatus according tothe invention,

FIG. 2 shows a solution in which information which facilitates patientpositioning is being presented on a screen connected to a mammographyapparatus,

FIGS. 3a, 3b and 3c show a mammography apparatus according to FIG. 1 inan oblique imaging position and as viewed from above,

FIG. 4 is a diagrammatic presentation of an arrangement for presentinginformation in connection with a mammography imaging apparatus, and

FIG. 5 is a flow chart of an automated image retrieval processapplicable for use in connection with the invention.

DETAILED DESCRIPTION OF THE INVENTION

A mammography apparatus (1) presented in FIG. 1 consists of asubstantially vertically standing frame part (10) and an arm structure(11) connected to it. An X-ray source (12) is arranged to the upper partof the arm structure (11), within its cover, the x-ray source (12) beingarranged to generate a beam which goes through an upper compressionplate (14) of the mammography apparatus (when such upper compressionplate is connected to the apparatus) and towards a detector (18) placedin a detector housing (13). The detector housing (13) or a correspondingstructure is typically arranged inside a lower tray structure (15). Thelower tray structure (15) can be a structure fixed to the apparatus orit can be arranged as removably connected. When the upper surface of thelower tray structure (15) typically functions as a platform on which abreast is positioned for imaging, this structure is often also referredto as a lower compression plate. Also, in connection with the armstructure (11), such as in the vicinity of the radiation source (12), acamera or a video camera aligned at the lower tray structure (15) mayhave been arranged, to be utilized in patient positioning. In thesolution according to FIG. 1, attaching means (16) is arranged to thelower tray structure (15) to enable its releasable connection to themammography apparatus (1). In addition, a screen (17) or a userinterface with a screen (17), to be described in more detail below, isarranged to the apparatus according to FIG. 1.

FIGS. 3a-3c show the apparatus according to FIG. 1 as viewed from aboveand in an oblique imaging position. Two screens (17), which may be touchscreens, are arranged to the frame part (10) of the apparatus, on theopposite sides of the frame part (10). Attachment of the screen (17) tothe frame part (10) of the apparatus may be articulated such that it canbe turned to both a first position in which it is aligned away from thelower tray structure (15) of the apparatus (FIG. 3a ), in connectionwith which structure the patient is positioned for imaging oroperations, and to a second position (FIG. 3b ) in which it is at leastpartly aligned towards the lower tray structure (15), i.e. in which itis in such position that the patient has a line of sight to the screen(17).

A position is presented in FIG. 3 intermediate to the previous positionswhich is applicable for consultation, for example, in which positionboth the operator of the apparatus and the patient have a good view atthe screen (17).

The screen (17) may be just a screen but preferably it is a truetraditional touch screen and it may also be some other user interfacecomprising a screen. Then the first position of the touch screen (17)according to FIG. 3a can be used when operations of the apparatus arecontrolled or when information is presented on the touch screen whichone does not want the patient to see or which the patient needs no tosee. Also the position according to FIG. 3b , and especially accordingto FIG. 3c can be used when controlling operation of the apparatus, butthose positions of the screen (17) are especially designed to be usedfor delivering information to the patient.

In reference to FIG. 4, according to one preferable embodiment of theinvention, the touch screen (17) is arranged in functional connectionwith the control system of the apparatus to display imaging parametervalues, for example, or the time remaining in the imaging process.Preferably, though, a functional connection like this is arranged e.g.to a patient data base, whereby one preferable embodiment according tothe invention includes a solution in which a touch screen (17) isarranged in a functional connection with an information system in whichimages of a patient taken earlier have been recorded. It is known assuch to use information achievable from such images to facilitatepatient positioning when the same object is being re-imaged or when abiopsy is to be started or is going on, which information may includemeasurement markings or other made to the images relating to findingswhich have been detected. According to prior art, though, such imagestaken earlier have been studied at some separate workstation, but thepresent invention makes it possible to bring the images to the immediatevicinity of the place where that information is needed. Then, thearrangement preferably includes a possibility to present images of apatient's breast taken earlier, especially in the same orientation inwhich the breast is being positioned to the imaging apparatus and inwhich images, as said, measurement markings or other may have been maderelating to findings which have been detected. FIG. 2 demonstrates asituation like this.

Especially the bringing of the touch screen in connection with theimaging station of a mammography apparatus makes it possible to altercharacteristics of an earlier image of the breast as well as puttingdown measurement markings as mentioned above on an image in connectionwith repositioning.

The screen or the user interface with a screen connected to amammography apparatus as presented above can be utilized in patientpositioning also if the mammography apparatus is equipped with a cameraor a video camera (19) aligned at the imaging station of the apparatus.A picture of a breast positioned for imaging may have been taken by suchcamera (19) in connection with an earlier imaging event (which cameramay have in principle been located at some other correspondingapparatus), which picture can then be shown in real time in connectionwith a new positioning, at the immediate vicinity of the imaging stationof the apparatus. On the other hand, also taking a real time photographof the imaging area may be useful in positioning, when the operator ofthe apparatus can have a look at the screen to review the positioningsituation, instead of following the situation in a possibly crampedspace outlined by the mammography apparatus and the patient.

When information one can acquire from prior images is directly availablein connection with patient positioning, such as information of locationof a finding detectable from earlier images, the present inventionprovides a possibility for smooth and precise positioning for re-imagingor biopsy. Further, the possibility to guide and inform the patient ofvarious stages of the imaging or biopsy event can help in achieving asuccessful procedure, by e.g. helping the patient to be still throughoutan operation which may take quite a while.

According to one alternative embodiment of the invention, the imagingarrangement comprises a means with the help of which images of patientsare recorded with identifiers such as patient identification,examination time, imaging modality and imaging procedure description.Such prior images can then be identified based on the identifiers and beautomatically retrieved from the information system by image retrievalmeans for subsequent scheduled procedures, to be presented aspositioning guides when new images are being acquired.

Moreover, prior mammography image(s) can be automatically loaded on atouch screen display of the workstation of the mammography imagingdevice based on choices made regarding the imaging procedure(s) to beperformed. For example, the mammography operator may be presentedinvestigation options, such as a work list, a study opened for apatient, a selected imaging mode, the breast that has been selected, orprojection(s). The present system can automatically select appropriateprior images based on the selected option(s). As such, the presentembodiment provides a user with a workflow which is simpler with lessreliant on memory than prior methodology. More particularly, usefulprior images can be automatically depicted on the touch screen and/ordisplay of the mammography apparatus based on the imaging to beperformed.

According to one alternative embodiment, the prior image isautomatically made available as a positioning guide at a screen of theimaging apparatus according to imaging parameters to be used. Theimaging parameter may be e.g. a selected imaging view and the priorimage of the corresponding view can be made automatically available. Thearrangement may thus include a means to be continuously aware of or torecognize on demand the acute orientation of the arm structure (11)supporting the x-ray source (12) and the detector housing (13) and ameans to correlate information of the acute orientation with a priorimage with an orientation identifier corresponding to the acuteorientation of the arm structure (11).

According to one further embodiment, the prior image to be presented ona screen is automatically adjusted so as to not present irrelevantinformation. For example, the prior image can be presented as zoomed orcropped to only show the relevant and/or visible anatomy. In thisregard, the present embodiment automatically can provide an otherwisefull size mammography image in a size fitted to a touch screen usedduring the imaging process itself. In one specific embodiment, croppingor zooming of the prior image is automatically performed such that thesystem automatically maintains the main point(s) of interest of the areato be imaged. Similarly, if there is labeling in the prior image, suchas items that have been marked, these can be used as automatic markersso that these marked items (and optionally some of the surrounding area)are captured in the imaging being performed. Furthermore, it iscontemplated that the present mammography arrangement may rotate (e.g.90°) prior images received from a typical workstation orientation to amap mode so that the displayed image corresponds in orientation to apositioning orientation of the breast associated to the mammographydevice.

FIG. 5 shows one exemplary procedure to realize the automated priorimage acquisition. When a follow up imaging of a patient is to beperformed, an automated search from the information system is made forany related prior images (prior studies) which are then stored at aworkstation. An exemplary work station can include a data inputmechanism, a monitor, and a computer processor (optionally remotelylocated). Upon initiation of the follow up imaging procedure,identifiers of the images of the previous study are compared withpositioning status at the imaging apparatus and in case a prior image atleast generally corresponding to the current positioning is found, theimage thus acquired is shown on a screen at the imaging apparatus,possibly as adjusted as discussed above.

Depending on the system available, the initial steps according to FIG. 5relating to first separately acquiring and storing the prior informationmay not be needed.

The invention can also be realized by the patient herself controllingoperation of the mammography apparatus from the user interface broughtin connection with the imaging station when the patient's breast isbeing compressed for imaging. Such solution is prone to lessen the fearsof the patient relating to compressing a breast, taking in considerationthat there are studies according to which a patient may allow themammography apparatus to compress a breast even more when she cancontrol the compressing process herself. The solution according to theinvention may thus offer the possibility to bring a touch screen (17)arranged to control operation of the mammography apparatus so close tothe lower tray structure (15) of the apparatus that the patient canherself control via it e.g. movements of the upper compression plate(14) of the apparatus according to FIG. 1.

In one embodiment of the invention the articulation of the screen (17)or the user interface with a screen (17) is realized as motorized. Then,at least one operation mode can be arranged to the control system of theapparatus according to which the screen (17) automatically turns into aposition which has been designated for it in that operation mode. Theposition of the screen (17) can thus be arranged to be changed accordingto which procedure that operation mode relates to, or according to whatthe control system displays on the screen. The screen (17) can bearranged e.g. to turn towards the patient when the time remaining in theimage process is displayed on the screen. On the other hand, also in thecase of an articulation being implemented to be turned manually, one ormore views may be defined in the control system which are automaticallydisplayed on the screen when it is turned into a position in which itcomes to the field of view of the patient, i.e. into a position asaligned towards the lower tray structure (15).

Solutions according to the invention and its preferable embodiments maythus include a mammography apparatus which includes a substantiallyvertically standing frame part (10) or a frame part (10) attachable to awall or a ceiling, an arm structure (11) connecting to this frame part(10) and pivotable in relation to a horizontal rotation axis, at asubstantially first end of the opposite ends of the arm structure (11)is placed an X-ray source (12), and substantially at a second end animage data receiving means (18), and in connection with said second endof the arm structure (11) is additionally arranged a lower traystructure (15) positioned substantially on top of the image datareceiving means (18), a control system and in connection with it a userinterface arrangement and at least one screen (17) or user interfacewith a screen (17). Said screen (17) or user interface with a screen(17) is connected to the mammography apparatus (1) and the connection isrealized such that the screen (17) or user interface with a screen (17)is aligned or can be aligned at least partly towards the lower traystructure (15). Further, a means is arranged to the mammographyapparatus (1) to bring said screen (17) or user interface with a screen(17) into a functional connection with an external information systemsuch that patient images recorded earlier in said information system canbe displayed on said screen (17) or user interface with a screen (17)connected to structures of the mammography apparatus. Preferably thearrangement includes a means for showing images on the screen (17) in anorientation corresponding to an orientation in which a breast ispositioned on top of said lower tray structure (15).

As patient positioning in mammography typically includes proceduresperformed on both sides of the lower tray structure, the invention getseffectively utilized when said screens (17) or user interfaces with ascreen (17) are arranged to the mammography apparatus (1) at least oneon both of its sides, as viewed from said lower tray structure (15).

The user interface arrangement may include at least one screen (17) oruser interface with a screen (17) which is

-   -   attached as articulated to the frame part (10) or    -   implemented with a technology by which a direction in which        information on the screen is visible is adjustable

so that a view generated by said at least one screen (17) or a userinterface with a screen (17) can be aligned at least at a firstdirection in which it is aligned away from said lower tray structure(15) and at a second direction in which it is at least partially alignedtowards said lower tray structure (15).

The at least at least one screen (17) or user interface with a screen(17) is attached to the frame part (10) as articulated. The articulationcan be realized as motorized and said control system to comprise atleast one operation mode according to which a view generated by thescreen automatically turns into a position determined for it by saidoperation mode, as dependent on the operation to which the operationmode relates to or on what the control system shows on the screen (17).The articulation can also include a structure which enables bringing thescreen (17) or the user interface with a screen into a substantialvicinity of the lower tray structure (15), especially within an arm'slength or closer.

One or several views can be defined in the control system to beautomatically presented on the screen (17) or a user interface with ascreen (17), when it is turned into its said second position.

The invention also concerns a method for positioning a breast into amammography apparatus, in which method an image taken of the breast isused as an aid for positioning the breast, which image is a patientimage recorded earlier in an information system external to themammography apparatus and said image is presented on a screen (17) or auser interface with a screen (17) attached to the structures of themammography apparatus. This image can be presented in a direction atwhich there is a line of sight from an imaging station of themammography apparatus, especially in an orientation corresponding to theorientation in which the breast is being positioned for mammographyimaging or for biopsy, in relation to the imaging station of themammography apparatus.

The invention claimed is:
 1. A mammography imaging arrangement, whichincludes a mammography apparatus, which includes a substantiallyvertically standing frame or a frame part attachable to a wall or aceiling, an arm structure connecting to said frame or frame part andpivotable in relation to a horizontal rotation axis, wherein at asubstantially first end of the opposite ends of the arm structure isplaced an X-ray source and substantially at a second end an image datareceiving means and wherein in connection with said second end of thearm structure is additionally arranged a lower tray structure,positioned substantially on top of the image data receiving means and acontrol system and in connection with it a user interface arrangement,at least one user interface with a screen, wherein said at least oneuser interface with a screen is connected to structures of themammography apparatus and located within an arm's length or closer of apatient positioned at the lower tray structure for imaging, theconnection being realized such that said user interface with a screen isaligned or can be aligned at least partly at said lower tray structure,and wherein a means is arranged to the mammography apparatus to bringsaid user interface with a screen into a functional connection with anexternal information system such that patient images recorded earlier insaid information system can be displayed on said user interface with ascreen connected to the structures of the mammography apparatus.
 2. Thearrangement according to claim 1, wherein the arrangement includes ameans for showing images on said user interface with a screen in anorientation corresponding to an orientation in which a breast ispositioned on top of said lower tray structure.
 3. The arrangementaccording to claim 1, including at least two user interfaces with ascreen, wherein said user interfaces with a screen are arranged to themammography apparatus at least one on both of its sides, as viewed fromsaid lower tray structure.
 4. The arrangement according to claim 1,wherein said at least one user interface with a screen belongs to a userinterface arrangement which is attached as articulated to the frame partor implemented with a technology by which a direction in whichinformation on the screen is visible is adjustable so that a viewgenerated by said at least one user interface with a screen can bealigned at least at a first direction in which it is aligned away fromsaid lower tray structure and at a second direction in which it is atleast partially aligned towards said lower tray structure.
 5. Thearrangement according to claim 4, wherein said at least one userinterface with a screen is attached to the frame part as articulated,the articulation being realized as motorized, and said control systemcomprises at least one operation mode according to which a viewgenerated by the screen of the user interface automatically turns into aposition determined for it by said operation mode, as dependent on theoperation to which the operation mode relates to or on what the controlsystem shows on the screen.
 6. The arrangement according to claim 4,wherein said at least one user interface with a screen is attached tothe frame part as articulated.
 7. The arrangement according to claim 4,wherein one or several views have been defined in the control system tobe automatically presented on the user interface with a screen when itis turned into its said second position.
 8. The arrangement according toclaim 1, wherein said user interface with a screen is a touch screen. 9.The arrangement according to claim 1, wherein a camera or a video cameraaligned at said lower tray structure is arranged in connection with thearm structure of the mammography apparatus.
 10. The arrangementaccording to claim 1, wherein the arrangement includes a means toinclude identifiers in the images to be recoded and image retrievalmeans to automatically present on the screen an image with a particularidentifier.
 11. The arrangement according to claim 10, wherein thearrangement includes a means to be continuously aware of or to recognizeon demand the acute orientation of the arm structure supporting thex-ray source and the detector housing and a means to correlateinformation of the acute orientation with a prior image with anorientation identifier corresponding to the acute orientation of the armstructure.
 12. A mammography imaging arrangement which includes amammography apparatus and which comprises a frame or a frame partattachable to a wall or a ceiling, an arm structure connected to saidframe or frame part and pivotable in relation to a horizontal rotationaxis, the arm structure including an X-ray source and an image datareceiving means, and a control system including at least one userinterface with a screen, wherein said control system is connected to anexternal information system remote from the mammography imagingarrangement such that a patient image recorded remote from themammography imaging arrangement can be displayed on said screen of theuser interface and/or used in positioning a breast and/or the armstructure during imaging and wherein said user interface with a screenis located within an arm's length or closer of a patient positioned atthe image data receiving means for imaging.
 13. The apparatus of claim12, wherein said patient image includes a patient identifier is selectedfrom patient identification, examination time, imaging modality andimaging procedure description.
 14. The apparatus of claim 13, whereinsaid patient identifier functions as a positioning guide for the armstructure during imaging.
 15. The apparatus of claim 12, wherein saidpatient image recorded remote from the mammography imaging arrangementis zoomed, cropped and/or rotated on said screen.
 16. The apparatus ofclaim 1, wherein said screen of the user interface is configured todisplay said patient image recorded earlier and studied at a separatework station.
 17. The apparatus of claim 16, wherein the image recordedearlier has been modified to include a measurement marking.
 18. Theapparatus of claim 12, wherein the patient image recorded remote fromthe mammography imaging arrangement is displayed on said screen of theuser interface with a measurement marking inserted at a remote workstation.